1. Declaration Control Number (DCN) Iowa Department of Revenue
IA 8453 2008
www.state.ia.us/tax
00- - - 9
Iowa Individual Income Tax
For the year January 1 - December 31, 2008
Declaration for an E-File Return
See Instructions
Your first name, middle initial Last name Your Social Security Number
Spouse’s first name, middle initial Last name Spouse Social Security Number
Home address (number and street) or PO Box
City, state and ZIP
B. Spouse A. You or Joint
(filing status 3)
Part I Tax Return Information
1. Iowa Net Income (IA 1040, line 26 A & B) ------------------------------------------------ 1B _________ .00 1A ___________ .00
ATTACH STATE COPY OF FORMS W-2, W-2G, AND 1099 HERE
2. Total Iowa Tax Before Credits (IA 1040, line 46 A & B) ---------------------------- 2B _________ .00 2A ___________ .00
3. Iowa Income Tax Withheld (IA 1040, line 60 A & B) --------------------------------- 3B _________ .00 3A ___________ .00
4. Amount to be Refunded (IA 1040, line 70) ----------------------------------------------------------------------------- 4 ___________ .00
5. Total Amount Due (IA 1040, line 75) -------------------------------------------------------------------------------------- 5 ___________ .00
Part II Declaration of Taxpayer
6a. I consent that my refund be directly deposited as designated below. If I have filed a joint return, this is an
irrevocable appointment of the other spouse as an agent to receive the refund.
6b. I do not want direct deposit of my refund or I am not receiving a refund. Go to “Sign Here.”
7. Name of Financial Institution _________________________________________________________________________
8. Routing Transit Number (RTN) The first two numbers of the RTN must be 01 through 12 or 21 through 32.
9. Depositor Account Number (DAN)
10. Type of Depositor Account: Savings Checking
Under penalties of perjury, I declare that the information I have provided to my Electronic Return Originator (ERO) and the amounts shown in Part I
agree with the amounts shown on the corresponding lines of the electronic portion of my Iowa income tax return. To the best of my knowledge and belief
my return is true, correct and complete. I consent that my return, including any accompanying schedules and statements, be sent to the Internal
Revenue Service (IRS) by my ERO and retrieved by the Iowa Department of Revenue (IDR). If I have filed a balance due return, I understand that if the
IDR does not receive full and timely payment of my tax liability I will remain liable for the tax liability and all applicable penalties and interest. I consent
that my refund be directly deposited as designated in Part II and declare that the information shown on lines 6a through 10 is correct. If I have filed a joint
or combined state return and elected direct deposit, there is an irrevocable appointment of the other spouse to receive the refund. If there is an error on
my Federal return, I understand my state return will be rejected. If the processing of my return or refund is delayed, I authorize the IDR to disclose to my
ERO and/or transmitter the reason(s) for the delay or when the refund was sent. I also consent to the IDR sending to my ERO and/or transmitter an
acknowledgment of receipt of transmission and indication of whether or not my return is accepted, and, if rejected the reason(s) for the rejection. I
understand that this declaration with required attachments must be forwarded upon request to the IDR.
Sign
Here Spouse Signature. If a joint return, both must sign. Date
Your Signature Date
Part III Declaration of Electronic Return Originator (ERO) and Paid Preparer
I declare that I have reviewed the above taxpayer’s return and that entries on form IA 8453 are complete and correct to the best of my knowledge. If I am
only a collector, I am not responsible for reviewing the return and only declare that this form accurately reflects the data on the return. The taxpayer will
have signed this return before submitting to the IRS. I have provided the taxpayer with a copy of all forms and information to be filed with the IDR, and
have followed all other requirements described in the Iowa Electronic Filing Handbook. I will keep form IA 8453, with attachments, on file for three years
from the due date of the return or the filing date, whichever is later, and I will make a copy available to IDR upon request. If I am a paid preparer under
penalties of perjury, I declare that I have examined the above taxpayer’s return and accompanying schedules and statements, and to the best of my
knowledge and belief, they are true, correct, and complete. This declaration is based on all information of which I have any knowledge.
Check if
ERO Date Check if ERO’s SSN or PTIN
paid preparer
Signature self-employed
EIN
Firm’s name (or yours
if self-employed),
address and ZIP code
Check if
Paid Preparer’s Date Preparer’s SSN or PTIN
self-employed
Signature
EIN
Firm’s name (or yours
if self-employed),
address and ZIP code
DO NOT MAIL Retain the completed form IA 8453 with your ERO records for three years. Furnish it ONLY upon request to IDR.
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2. If the ERO makes any changes to the
the number from left to right leaving the
The IA 8453 is not required when using electronic return after the taxpayer has signed
unused boxes blank.
the Self-Select PIN method. the IA 8453, but before it is transmitted, the
To be eligible for Direct Deposit, taxpayers
ERO must complete and obtain the taxpayer’s
The IA 8453 must be completed and must provide proof of account ownership to
signature on a new IA 8453 if either of the
signed when the Practioner PIN method their ERO. Acceptable proof of account
following applies:
is used or a State Only return is eFiled. ownership is a check, form, report, or other
• The Iowa Net Income (the total of lines 1A
statement generated by the financial
and 1B of form IA 8453) is different from
institution that has the taxpayer’s name, RTN
the amount on the electronic return by
of the financial institution, and the depositor
Instructions for IA 8453
more than $50.00, or
account number preprinted on it. A deposit
The IA 8453 must be completed, signed by all slip should not be used to verify the RTN • The Total Iowa Tax Before Credits (lines
parties, and attachments affixed prior to and account number because it can contain 2A and 2B, IA 8453), Iowa Income Tax
transmission of the electronic return. The internal routing numbers that are not part Withheld (lines 3A and 3B, IA 8453), the
Electronic Return Originator (ERO) is of the RTN. Amount to be Refunded (line 4, IA 8453)
responsible for retaining the completed IA
or the Total Amount Due (line 5, IA 8453)
For accounts that are payable through a
8453 with attachments for three years from
differs from the amount on the electronic
financial institution other than the one at
the return due date or the actual filing date
return by more than $14.00.
which the account is located, the taxpayer
whichever is later. The ERO is responsible for
must provide a document, such as an account If changes are less than the amounts above,
providing the IA 8453 with attachments to the
statement or account identification card, the ERO may write them in and initial the
Iowa Department of Revenue (IDR) upon
showing the RTN of the bank or institution corrections.
request.
where the account is located.
Declaration Control Number (DCN)
If there is any doubt about the correct RTN, Part III Declaration of Electronic
The DCN is a 14-digit number assigned by the
the taxpayer should contact the financial Return Originator (ERO) and Paid
ERO to each taxpayer’s return.
institution and ask for the correct RTN for Preparer
Name, Address, Social Security Number Direct Deposits (Electronic Funds Transfers).
The ERO must sign form IA 8453. The paid
If it is a joint or combined return, be sure the Note: Some financial institutions may not preparer must sign form IA 8453. If the paid
names and Social Security Numbers are listed accept Direct Deposits into accounts that are preparer is also the ERO, do not complete the
in the same order as on the electronically-filed payable through another bank or financial paid preparer’s section. Instead, check the box
return. institution, including credit unions. labeled “Check if paid preparer.” If the paid
Note: The address must match the address preparer is not available to sign the IA 8453,
The account designated to receive the Direct
shown on the electronically-filed IA 1040. attach the paper IA 1040 signed by the paid
Deposit must be in the taxpayer’s name. If the
preparer to this document and mark the IA
taxpayer’s filing status on the return is
1040 “COPY ONLY.”
married filing jointly or separately on a
Part I Tax Return Information
combined return, the account can be in either Refunds
Use whole dollars only in this area. Enter
or both spouses’ names. If the filing status is After IDR has acknowledged receipt of your
amounts from the IA 1040, as specified. No
married filing separately, the account can be return, the refund should be issued within two
computation is required. All Iowa returns will
in the taxpayer’s name, or it can be a joint weeks. If you elect to have the refund directly
be transmitted as IA 1040 long forms.
account in both spouses’ names. deposited into a savings or checking account,
If there is an amount due, the taxpayer has
Some financial institutions do not permit the your account may be credited even sooner.
three options to pay:
deposit of a joint refund into an individual Automated Refund Information
1. Go to the IDR Web site and choose to ePay account. Iowa Department of Revenue is not
Refund information is available on our Web
(direct debit), or responsible when a financial institution
site at www.state.ia.us/tax or call 1-800-572-
refuses a Direct Deposit for this reason.
2. Go to the IDR Web site and pay with a
3944 (Iowa only) or 515/281-4966.
credit card, or Both spouses must sign the form IA 8453 for Attachments to the IA 8453:
a joint or combined return.
3. Mail your payment with the completed IA
• The state copy of form W-2, W-2G and
1040-V. The taxpayer’s signature permits IDR to
any 1099.
advise the ERO and/or transmitter of the
If the return is timely filed but less than 90%
•
reason(s) for any delay in processing the
of the tax is paid by April 30, 2009, a 5% A copy of the other state’s tax return, if
return or refund and if the return has been
failure to timely pay penalty will apply, plus the IA 130 was completed or the Iowa/
rejected, the reason(s) for the rejection.
interest. Illinois reciprocal was claimed.
Part II Declaration of Taxpayer
The depositor account number (DAN) can
contain up to 17 alphanumeric characters. Do not mail the IA 8453.
Include hyphens, but omit spaces and special
Retain with your records
symbols. If fewer than 17 characters, enter
for three years.
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